Combination of the placental alpha-1 microglobulin test and ultrasonic cervical length measurement to predict the time of preterm birth.

OBJECTIVE: To evaluate the combined identification of placental alpha-1 microglobulin (PAMG-1) in cervicovaginal secretions and ultrasound cervical length measurement in pregnant women with symptoms of threatening premature bith (PB) and intact fetal membranes to predict the time of labor onset. MATERIALS AND METHODS: A prospective observational study including 137 pregnant women at a gestational age of 22-37 weeks with symptoms of PB. Presence of PAMG-1 was determined using the commercially available PartoSure test kit (Parsagen Diagnostics Inc, Boston, USA) and the cervical length was measured using ultrasound. RESULTS: Ultrasound cervicometry in women with the cervical length between 15 and 30 mm had a positive predictive value of only 8.9% for PB within 7 and 14 days. The PartoSure test in women with the cervical length between 15 and 30 mm had the positive predictive value for PB within 7 and 14 days of 63.6%. CONCLUSION: Using the combination of ultrasound cervicometry and PAMG-1 testing in women with symptoms of PB and the cervical length between 15 and 30 mm may allow to identify those with a high risk of PB within 7 and 14 days more accurately.

Comparative assessment of arabin pessary, cervical cerclage and medical management for preterm birth prevention in high-risk pregnancies.

OBJECTIVE: This study aimed to compare the efficacy of combined use of Arabin pessary, cervical cerclage and progesterone with progesterone-only management of pregnant women at high risk of preterm birth. MATERIALS AND METHODS: The study included 203 pregnant women at high risk of preterm birth who were randomised to receive Arabin pessary (Group 1, n = 82) and progesterone, circular cervical cerclage and progesterone (Group 2, n = 121) or progesterone treatment only (Group3, controls, n = 50). Patients in the pessary and cerclage group also received progesterone. RESULTS: The use of Arabin pessary combined with progesterone resulted in a 2.5-fold decrease in the rate of vaginal dysbiosis in pregnancy (p = 0.015) and almost three-fold reduction in in the postpartum period (p = 0.037), combined with circular cervical cerclage and progesterone. Suture eruption was observed in 4.3% of women. In patients with abnormal placental location, placental migration was observed in 62.1% of patients in Group I, 52.1% in Group II and a significantly lower proportion of patients (14.0%) in Group III (p = 0.001). Bleeding during pregnancy was observed significantly more often in both comparison groups (p = 0.005). Incidence of intrapartum bleeding was 17.4% (p = 0.011) in Group II and 24.5% in Group III (p = 0.002). Intrapartum chorioamnionitis was observed in 4.3% of patients in Group II and 2.04% of patients in Group III. CONCLUSIONS: The use of Arabin pessary compbined with progesterone reduces the rate of infectious complications and bleeding during pregnancy and the postpartum period.